Esophageal adenocarcinoma is associated with a very poor prognosis. More effective screening, surveillance, and treatment strategies are required. The overall aim of this pilot proposal is to develop methodologies that will facilitate future multicenter studies aimed at assessing the familial aggregation of Barrett's esophagus and esophageal adenocarcinoma. Three specific methodologies will be developed: 1. A multicenter network will be established at five different institutions to enable the measurement of the prevalence of familial Barrett's esophagus. Familial Barrett's esophagus will be identified by administration of a questionnaire that has already been tested at University Hospitals of Cleveland. 2. Methodology will be developed to screen symptomatic first degree relatives of index patients with Barrett's esophagus and esophageal adenocarcinoma. Relatives with gastroesophageal reflux disease who have already been identified at University Hospitals of Cleveland through the study questionnaire will be recruited for screening endoscopy via mailings and phone calls. 3.Methodology will also be developed to recruit and screen asymptomatic or mildly symptomatic first degree using a new battery powered ultrathin endoscope. Successful conduct of this research proposal will result in the creation of a multi-center network, the identification of families with aggregation of Barrett's esophagus and esophageal adenocarcinoma, and the development of methodology for detecting Barrett's esophagus in previously undiagnosed family members. These three achievements will permit future full-scale multi-center epidemiologic and genetic linkage studies with the ultimate goals of measuring the familial risk of Barrett's esophagus and the identification of susceptibility gene(s) that predispose individuals to the development of Barrett's esophagus. The results of these future investigations will aid the development of lower cost, more effective screening and surveillance programs for Barrett's esophagus. They will also define a population at risk in whom interventions to prevent or eradicate Barrett's esophagus can be applied.